The disclosed subject matter relates generally to techniques and devices for spatially controlling and mechanically tensioning constructs for tissue reinforcement using integrated fastener-anchors, including techniques for reducing hernia risk following surgery via mesh onlay fixation to the abdominal wall fascia.
Incisional hernia (IH) is a protrusion of intra-abdominal contents, often intestines, through the abdominal wall, which can be the result of a failed or disrupted fascial closure after surgical incision through the abdominal fascia. The incidence of hernia can be approximately 13% and can be as high as 70% following incisions to the abdominal wall in certain high risk patient populations, and the cost burden for hernia is significant. Further, hernias can be debilitating for patients and associated with a significant decrease in quality of life.
IH are treated after they occur, typically and most effectively reinforced with mesh to reduce subsequent recurrence. However, even with certain available techniques, approximately 1 in 3 repaired hernias will recur, and with each failed repair the chance of success decreases and costs increases. The compounded challenge of failed repairs coupled with associated costs and morbidity, underscores the need for prevention.
One strategy to prevent IH is to use prophylactic mesh augmentation (PMA) at the index abdominal surgery procedure to reinforce the fascia of before herniation actually occurs. PMA can be implemented to reduce risk and morbidity, and contain cost in high risk patients undergoing abdominal fascial incisions. However, a simple, reliable, and precise mechanism and system to provide PMA is needed. Current challenges of widespread PMA adoption include the added operative, technical challenges related to mesh anchoring and fixation, variability in technique, and uncertain biomechanical benefit and mesh tensioning. Although suturing or fastening the mesh by hand can be effective, this can add operative time and may be subject to user technical ability. Person-to-person variability, added operative time, and biomechanical benefit are thus issues affecting adoption of this technique.